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Open Reduction and Internal Fixation of Radial Head Fractures: Do Outcomes Differ Between Simple and Complex Injuries?

  • Symposium: Traumatic Elbow Instability and its Sequelae
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive.

Questions/purposes

We compared patients undergoing ORIF for isolated radial head fractures or for radial head fractures associated with other fractures or elbow dislocations in terms of patient-related disability, presence of posttraumatic arthritis, complications, and rate of reoperation for capsular release.

Methods

Between 1997 and 2008, 52 patients underwent ORIF of the radial head for isolated radial head fractures (simple group) and 29 underwent ORIF for radial head fracture with an associated fracture or dislocation (complex group). General indications for ORIF included displaced radial fractures, large articular surface fragments, and greater than 2 mm of displacement and/or a mechanical block to forearm rotation or associated fractures or ligament injuries requiring surgery. Thirty-one patients (60%) in the simple group and 20 (69%) in the complex group were available for followup at a mean of 4 years (range, 1.0–9.5 years). We evaluated the patients using a validated self-reported pain and disability questionnaire (Patient-rated Elbow Evaluation [PREE]). Records review included radiographic examination and assessment of major complications and secondary surgery rates for capsular release.

Results

With the numbers available, the groups were not different in terms of the mean PREE scores (8 versus 15 for the simple and complex groups, respectively; p = 0.13, lower values indicate lower pain and disability). The simple and complex groups were also not different with the numbers available in terms of major complications (13% versus 25%, respectively; p = 0.29) or secondary capsular release (3% versus 20%, respectively; p = 0.07).

Conclusions

At short term, we found no differences between patients treated with ORIF for isolated radial head fractures and those treated for radial head fractures in association with other elbow injuries with regard to pain and disability scores; loss to followup in this series precludes making statements with great confidence about function after these injuries. However, the substantial capsular release and complication rates should weigh into the preoperative discussion with patients before selecting ORIF for radial head fractures.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors acknowledge Chris Young BSc for his assistance in collecting data for this investigation.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of British Columbia, 590-1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada

    Jeffrey M. Pike MD, MPH

  2. St Joseph’s Health Centre, University of Western Ontario, London, ON, Canada

    Ruby Grewal MD, MSc, George S. Athwal MD, Kenneth J. Faber MD, MHPE & Graham J. W. King MD, MSc

Authors
  1. Jeffrey M. Pike MD, MPH
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  2. Ruby Grewal MD, MSc
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  3. George S. Athwal MD
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  4. Kenneth J. Faber MD, MHPE
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  5. Graham J. W. King MD, MSc
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Corresponding author

Correspondence to Jeffrey M. Pike MD, MPH.

Additional information

One of the authors (GJWK) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Wright Medical Technologies, Inc (Arlington, TN, USA). All other authors certify that they, or a member of their immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles for research, and that informed consent for participation in the study was obtained.

This work was performed at the University of Western Ontario Hand and Upper Limb Centre, London, Ontario, Canada.

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Pike, J.M., Grewal, R., Athwal, G.S. et al. Open Reduction and Internal Fixation of Radial Head Fractures: Do Outcomes Differ Between Simple and Complex Injuries?. Clin Orthop Relat Res 472, 2120–2127 (2014). https://doi.org/10.1007/s11999-014-3519-8

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  • DOI: https://doi.org/10.1007/s11999-014-3519-8

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